Worrying trends

Rising overdose deaths, the continued availability of new psychoactive substances and the growing health threat of highly potent synthetic opioids are among the key issues highlighted by the report.

Overdose deaths on the rise for third consecutive year

The report highlights concern over the increasing number of drug overdose deaths in Europe, which has risen for the third consecutive year. A total of 8 441 overdose deaths, mainly related to heroin and other opioids, are estimated to have occurred in Europe in 2015 , a 6% increase over 2014. Increases were reported in almost all age groups. Rises in overdose deaths in 2015 are reported in Germany, Lithuania, the Netherlands, Sweden, the UK and Turkey. Europe’s 1.3 million problem opioid users are among the most vulnerable.

Opioids used in substitution treatment — primarily methadone and buprenorphine — are also regularly found in toxicological reports. Latest data show that the number of recorded methadone-related deaths exceeded heroin-related deaths in Denmark, Ireland, France and Croatia, underlining the need for good clinical practice to prevent diversion of these substances from their legitimate use.

Interventions to prevent overdoses in Europe include supervised drug consumption room (DCRs) and the provision of ‘take-home’ naloxone (opioid overdose-reversal drug) to opioid users, their peers and families. There are now 78 DCRs now operate in 7 European countries (but not the UK). Take-home naloxone programmes now exist in ten countries; including Scotland and Wales but with very patchy provision in England.

New drugs emerging at a slower pace, but overall availability still high

New psychoactive substances (NPS/‘new drugs’) remain a considerable public health challenge in Europe. Not covered by international drug controls, they include a broad range of synthetic substances, including cannabinoids, cathinones, opioids and benzodiazepines.

In 2016, 66 NPS were detected for the first time via the EU Early Warning System (EWS) — a rate of over one per week. Although this number points to a slowing of the pace at which new substances are being introduced onto the market — 98 substances were detected in 2015 — the overall number of substances now available remains high. By the end of 2016, the EMCDDA was monitoring more than 620 NPS (compared with around 350 in 2013).

The slower rate of new detections in Europe may be attributed to a number of factors. New legislation in some Member States (e.g. blanket bans, generic and analogue-based controls) has created a more restrictive legal environment, in which there may be less incentive for producers to engage in a‘cat-and-mouse game’ with regulators, where innovation is used to keep ahead of controls. Law-enforcement operations and control measures targeting NPS laboratories in China may also be contributing to the slowdown.

EMCDDA Director Alexis Goosdeel says:

Our latest findings suggest that responses to new psychoactive substances, such as new legislation and measures targeting the high-street shops that sell these products, may be having an impact on the emergence of NPS on the market. But despite positive signs of a slowdown in product innovation, overall availability remains high. We are seeing sales of these drugs becoming more clandestine, with transactions moving online or onto the illicit drug market, and we have witnessed the recent appearance of some highly potent substances, which have been linked to deaths and serious intoxications.

New synthetic opioids — highly potent and a growing health threat

In Europe, as in North America, highly potent synthetic opioids, which mimic the effects of heroin and morphine, are a growing health threat. While representing a small share of the market, there are increasing reports of the emergence of these substances and of the harms they cause, including non-fatal intoxications and deaths. Twenty-five new synthetic opioids were detected in Europe between 2009 and 2016 (18 of these were fentanils).

With only small volumes needed to produce many thousands of street doses, new synthetic opioids are easy to conceal and transport, posing a challenge for drug control agencies and a potentially attractive commodity for organised crime. They are found in various forms — mainly powders, tablets and capsules — with some now available as liquids and sold as nasal sprays.

Fentanils are subject to particular scrutiny. These exceptionally potent substances — some many times more potent than heroin — accounted for over 60% of the 600 seizures of new synthetic opioids reported in 2015. Eight new fentanils were reported through the EWS for the first time in 2016 alone. These substances pose a serious risk of intoxication, not only to users but also to those who may be accidentally exposed to these drugs (e.g. via skin contact, inhalation), such as postal and customs workers and emergency service personnel.

Signs of rising cocaine availability

Europe’s most commonly used illicit stimulant drugs are cocaine, MDMA (sometimes referred to as ‘ecstasy’ in tablet form) and amphetamines (amphetamine and methamphetamine). Cocaine use is higher in western and southern European countries — reflected in ports of entry and trafficking routes — while use of amphetamines is more prominent in northern and eastern Europe. The stimulant market has become increasingly complex in recent years, with the arrival of new stimulants (e.g. phenethylamines and cathinones).

Data from wastewater monitoring and on seizures, price and purity suggest that the availability of cocaine may be rising again in parts of Europe

Global cannabis policy developments: what implications for Europe?

Recent changes in the regulatory framework for cannabis occurring in parts of the Americas have generated interest among policymakers and the public in Europe although it is not yet clear what the pros and cons of different approaches are.

Regardless of any wider impact on drug policy, the existence of a commercially regulated cannabis market in some countries outside Europe is fuelling innovation and product development (e.g. vaporisers, e-liquids, edible products), which may, in time, impact on patterns of use in Europe.

Some 87.7 million European adults (15–64 years) have tried cannabis in their lifetime. Of these, an estimated 17.1 million are young Europeans (15–34 years) who have used cannabis in the last year. Around 1% of European adults are daily or almost daily cannabis users (use on 20 days or more in the last month).

EU and US: school student substance use compared

Monitoring substance use among school students offers valuable insight into current youth risk behaviours and potential future trends. This year’s report compares long-term patterns of substance use among European and American students (15–16 years), following the release of two major school surveys in 2016. The surveys show smoking and drinking among school students in Europe and the US to be declining, while trends in cannabis use appear to be more stable.

Last-month cannabis use among the European school students surveyed (21 EU countries and Norway), was around half the level (8%) of that reported in the US (15%). Last-month tobacco use was almost four times higher among students in Europe (23%) than in the US, where it was low at 6%. Tobacco use among US students was less than half the level of cannabis use in this group. The percentage of European students reporting last-month alcohol use was more than double (49%) that reported by their American peers (22%).

Conclusion

In my opinion, these annual EMCDDA reports have improved markedly over recent years; not only are they more comprehensive and more reliable but they are more directly focused on emerging behaviours and risks, enabling governments to focus their response in the most important areas. Let’s hope we publish our, rather overdue, drug strategy in the immediate future.

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